Meeting the physician retention challenge

By Carol Westfall

Recruiting highly skilled physicians has long been a focus f4or medical groups. A survey of nearly 100 medical group leaders now shows growing concern about retaining the valuable physicians they have worked so hard to recruit, train and integrate into their practices.

The Cejka Search and AMGA Physician Retention Survey found that nearly half (47 percent) of all medical groups have strong concerns about turnover and more than one-third (36 percent) placed turnover among the top three critical issues facing their group practice. To address these concerns, 58 percent of the groups stated they have designated retention initiatives compared with 48 percent in 2004, an increase of 21 percent; 41 percent reported having written materials that are used for retention compared with 27 percent in 2004.

This increased concern regarding physician turnover and focus on retention strategies are reflected in the survey findings, which include the following data.

Why and when physicians are leaving. Compensation is not the top reason for physician turnover. Of the voluntary resignations, the survey found that 44 percent cited practice issues as a reason for their departure; 21 percent reported compensation as a factor; 21 percent said a change in location was a contributor; and 14 percent cited spousal issues.

To better understand the components driving each reason cited, respondents identified the following:

· Of the physicians leaving for practice issues, “poor cultural fit” is cited more frequently than any other reason (19 percent). “Work pressure and hours incompatible with quality lifestyle” is next (18 percent).

· Of the physicians who left because of compensation, “disappointment in compensation” is the prevailing reason (45 percent). “Recruited away for better compensation” is the next reason, cited 22 percent of the time.

· Of those leaving due to location, 33 percent do so to be “closer to extended family;” 23 percent leave only for a “different geographical location;” 22 percent leave because the “physician and his/her family did not adjust well to the community.”

· Of those leaving for spousal concerns, three issues dominate: spouse transfer (32 percent), “spouse unhappy with location” (28 percent), and “move closer to spouse’s family” (26 percent).

Of those physicians who left, the survey found that: 60 percent leave in the first five years; 47 percent left in the first three years; and of the nine percent leaving in less than one year, 22 percent are newly out of residency or fellowship.

How medical groups are monitoring and responding to the retention challenge. The survey revealed a significant increase in the number of medical groups that reported they are tracking turnover. Overall, 90 percent of the respondents said they monitor turnover, which is a 23 percent increase over last year.

When segmented by practice size, all medical groups with more than 500 physicians said they track turnover, as do 80 percent of the smallest groups – those with fewer than 50 physicians.

This level of focus on monitoring turnover is understandable because the effects of turnover can be far-reaching, adding pressure to the group practice. When asked how turnover affects their groups:

· 76 percent of respondents said that increased workloads add to stress on remaining physicians.

· 46 percent said that it adds to the burden on senior leadership due to re-recruitment and interviewing schedules.

· 40 percent said decreased morale results from turnover.

Differences in how groups approach recruitment and retention. A number of the survey findings revealed directional trends that highlight differences in how groups approach recruitment and retention based on their size and resources. Most respondents seem to agree that building a positive environment for physicians begins when a physician signs with a group practice. More than eight of ten (81 percent) of all groups begin retention efforts between signing and starting date.

Groups with more than 500 physicians reported less concern about turnover and assign a lower priority to turnover on their list of critical issues. At the same time, however, they reported more concern about recruitment. They are more heavily focused on interviewing techniques and employ a diversity of resources in recruitment.

By contrast, smaller groups emphasized retention efforts centered on communication and engagement with leadership, flexibility in work arrangements, and earlier advancement into partnership and profit-sharing arrangements, which are also important to retention.

Although not statistically conclusive, we believe that the findings and directional trends indicate that the additional resources available to larger groups for formalized recruitment and retention programs may be effective in lowering turnover. Annual turnover was 6.4 percent for all medical groups responding – 5.2 percent for medical groups with more than 500 physicians and 6.9 percent for those with less than 500 physicians.

The challenge of retention in the future. Although many organizations are actively implementing retention programs, the majority of survey respondents project that the physician turnover rate will continue to increase.

Two-thirds (68 percent) of all the groups surveyed projected that the physician turnover rate will increase nationally before 2007. The remaining third (32 percent) anticipated that national turnover will decrease or stay the same. Among all respondents, only TWO percent anticipated that national turnover will decrease.

With regard to their own groups, respondents viewed their anticipated turnover more optimistically. More than half of the respondents (52 percent) reported that their group would not see a significant change in turnover in the coming two years. However, this optimism may be linked to the projected success of retention programs.

The importance of integrating recruitment and retention practices. In our experience, successful practices are implementing retention efforts at the time of recruitment and throughout a physician’s career. These efforts were also evident in the results of the survey. Between signing and start dates:

· 81 percent of all respondents indicate their new hires receive a “personal call from leadership.”

· 58 percent indicate a “mentor is assigned” during this window.

· 52 percent indicate they bring the newly hired physician back for a “return visit” to their facility.

Some differences were evident among the size and type of groups responding to the survey. Nearly twice as many physician-owned groups (70 percent) than hospital/system-owned groups (38 percent) assign mentors during this time period.
During the first 90 days after hire, large groups communicate with newly hired physicians at a lower rate than average. Fewer of the groups with more than 500 physicians participate in the following key retention areas, while small groups with three to 50 physicians report above average participation in these areas:

· Extra communication with new physicians.

· Clear expectations about compensation.

· Feedback sought from new physicians.

Groups are evaluating their practice culture and interviewing candidates to assess how well they will “fit” within their culture. Group leaders are involving family and spouses in the recruitment phase, and focusing heavily on frequent and clear communication with the newly hired physician. A group that communicates and demonstrates that they value satisfaction and retention will better attract new candidates to support growth over the long term.

Across the nation, retaining physician talent is receiving attention among medical groups and other health care organizations. With the current and projected shortage of physicians, and corresponding challenges to recruitment, the slightest increase in turnover can have a significant financial and service delivery impact. It has become critically important to incorporate an active retention plan into a medical group’s core strategy – and secure top leadership’s commitment to an integrated recruitment and retention strategy.

Carol Westfall is president of Cejka Search.